I'm glad you're taking time for you, to heal both physically & mentally. While I haven't walked the IVF path either, my heart aches for you.

Re: Acupuncture. I know I think the world of my husband's chiropractor/acupuncturist. After nearly 3 years of chronic back pain/tightness from an injury (that 2 years of traditional PT & medicine barely touched), "dry needling" acupuncture with chiro adjustments basically fully took away his pain in <6 months of treatment. If you can find a chiropractor that is covered by your insurance who also does acupuncture (I think ours gives 12 visits/year), I'd highly recommend that route. I know there are some in our area who do fertility-focused treatments. His chiro visits/adjustments were covered (& those include basically a mini-massage), & the acupuncture was like a $30-40 add on that we paid with our Healthcare Flex Spending account (price flexed depending on if it was just his back, or back + hamstrings/quads). I have had friends who have had great results with acupuncture for things like migraines & stress. You might also want to check to see if your insurance covers massage-- some do. I think we can get like 12 visits a year for massage too...although I haven't explored that (but I totally should!). The problem is there are just few in our area that can process insurance paperwork (most tend to be located at Chiropractor practices).

Re: Metformin. I feel like a cheerleader in the Metformin Fan Club. I personally love the stuff. I noticed a big difference in my cycles AND my mood issue tendencies with Metformin (lifelong anxiety/depression cycle). My final dosage is 1000mg ER twice-a-day (2000mg ER total)....which might be the max dosage of the ER formula. If you are noticing chronic stomach issues with the Metformin, you might want to ask your doctor about taking the Extended Release formula (ER)...but make sure your insurance covers it first, even the generic is pricey (like $600-700/month). Like @KnitorMiss mentioned, you might want to be careful with dairy before/after your dosage. I didn't find a reaction with cheeses...but traditional milk or something like ice cream...It's unpleasant. I never could break my "milk addiction", but I have found that the reaction is less with lactose-free milk (lower sugar/carb). And nearly a year after starting to take it, my GI symptoms in general are basically gone with the Met. (unless I take it on an empty stomach in the morning & then space eating breakfast...then my stomach still complains a bit...understandably so). I personally give Met the credit in my ability to conceive after nearly 6 years of trying...I can't imagine a life without Met at this point.

If you don't have any talk therapy options covered by your insurance, I'd consider joining a local infertility group. Many of them have moderated group meetings, that are essentially group therapy. It might help to connect 1:1 in-person with people facing the same issue. Someone at your infertility practice may be able to connect you with a local group.

Above all, take care of you. {Hugs!}

@KnitorMiss I think Metformin has a lot of benefits besides just the lowering of the A1C/glucose/insulin level labs. I know it lowers free floating estrogen & androgens, which are one of the things that mess up cycles with women with PCOS (& probably what doesn't jive with your continuous BC). I think there is some sort of affect on progesterone as a result, because I know my progesterone lab levels were horrible pre-Met (probably triggering the irregular/long cycles), & those improved drastically after a few months on Metformin with no more Provera supplementation minus a "kick-start" a month into Metformin. I know there have been several studies over the past decade that have shown benefits of Metformin in relation to cancer (both in helping to prevent, & in prolonging life or aiding in cure for those with specific types of cancers...but I'm not in a place where I have my usual access to study resources right now ). I think there are also a few studies showing Metformin's ability to improve heart function in women & provide protection against heart disease (but if I remember correctly, it had an opposite affect for men...I wonder if part of that is decreasing estrogen? I don't know...I'm so far out from my physio classes to remember all of the micro/hormonal pathways...lol).

Regarding the dosage, I'm not an expert in that area...because my OBGYN (who treats A LOT of PCOS patients & has PCOS herself) was pretty adamant that I needed to be on max dosage to conceive due to my long history of irregular cycles, my mom's difficulty conceiving (probably PCOS, but never diagnosed), & my strong family history on both sides of T2 Diabetes....so I never had a "middle step" on my Met, I just ladder-stepped week by week up to max dosage...lol. I started with the normal Met & then was transitioned to the XR about halfway through. I don't even remember what my insulin lab values were (the practice has switched e-medical record programs since then, & the old labs aren't listed), but I know I've never had a high A1C or fasting glucose level...but I was destined to eventually with how IR works.

I know my dad is on half of the dosage of the Met XR that I am (500 b.i.d XR)...as he so lovingly pointed out when he was at my house the other week & saw my pill bottle...lol. I can't convince my parents why I'm on Metformin when I don't have "diabetes." And it's a whole other fight to convince them it's not bad for the baby for me to still be on it (since PCOS women are more prone to Gestational Diabetes & pre-eclampsia, & there are zero studies showing harmful effects on baby as long as they are growing...which she is). I know my dad is within the "normal weight range" now, and I think his Metformin dose was dropped once his A1C regulated & he reached "normal weight" (he was diagnosed with T2D after he had an issue with peripheral vascular disease pop up suddenly). But he's still on it despite normal weight & labs, & will be for life.

Personally, I would do whatever you are most comfortable with. If you *really* don't want to restart the Met...don't. Just follow the plan that has dropped your levels before & be sure to get your follow-up labs to make sure it's working. Everyone's different. I fully realize that because Met's a miracle worker for me, it won't be for everyone. That being said, if you're willing to give it another go...it might be worth trying the 250 to see how your body responds this round? If anything, it could offer a bit of protection when plans go awry because of life events?

Hiya been away for awhile but back again

There has been a great deal of discussion in the low carb forum about how under-regulated the generic forms are of most medication, specifically of Metformin. If your doctor does want you continue on the Metformin, I would request the brand name medication, Glucophage. It could very well make a difference, @LolaDeeDaisy23 ...

That being said...and I don't want to say this and be a total jerk and be wrong, but after my miscarriage, I started feeling crazy tired, listless, uninterested in walking or doing the things I'd done, and all kinds of mess. I was depressed and basically wanted to do nothing, really. I was not taking any medications at the time (not related, anyway). I had absolutely no idea at the time, but I was pregnant. It would be at least 4-8 weeks later before that even occurred to me to wonder, but as I was hopeless about the whole situation, it took ages before it occurred to me. Apparently my coworkers suspected long before I did, and started trying to figure out how to test me without me knowing and stuff, because they didn't want to get my hopes up and such.

I have know people to talk about having to get off Metformin while actually pregnant, and others who did not have to do so or needed to stay on it. I am not saying this is what is happening at all, but that was my first thought. I know after all you've been through, at this point, feeling hopeful is probably quite painful, but ... I never had a cycle after my miscarriage. In fact, I was worried that I wouldn't get one again and be able to try again. They had told me I had to get a cycle before I had any chance of conceiving again... They were wrong. I didn't have to do egg transfers, and honestly, I've been told that it was my miscarriage, triggering a weird flush situation that enabled me to be able to get pregnant the way I did...

I so apologize if this is painful to you to even consider, which I hope it's not, since you're optimistic about trying the transfer again, but...having been on inositol and met for this time, it could have made a difference, perhaps Regardless of my thoughts on the matter, I wish you the utmost success in your next transfer! I'm glad to see that taking care of yourself has made a difference in your outlook on everything... (HUGS)